PR-1827, 10/10 Statement of Termination or Confirmation of Interest(s) in Property (Informal Administration) 247247705.15, 865.20 and 865.201, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Statement of Termination o r Confirmation of Interest(s) in Property ( Informal Administration) Case No. UNDER OATH, I STATE: 1. I am the personal representative in this estate. 2. The decedent, with date of birth and date of death , was domiciled in County, State of , with a mailing address of . 3. At the time of death the decedent had the following interests(s) in property in County, Wisconsin: joint tenancy. life estate. survivorship marital property. interest in real property with a designated transfer on death beneficiary. interest passing by nontestamentary disposition under a marital property agreement. (copy attached or previously filed) recording data are as follows: See attached Description of Property and Recording Data from creating document (If any) Name of Person Receiving Property State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Personal Representative Name Printed or Typed Date Personal Representative Name Printed or Typed Date Form completed by: (Name) Address Telephone Number Bar Number (If any) American LegalNet, Inc. www.FormsWorkFlow.com